Benefit open enrollment guide: optimize costs and retention

Open Enrollment Checklist: A Cost Decision, Not a Date

August 01, 2026

Family premiums hit $26,993 in 2025, up 6% from the year before. That number lands on your desk during renewal, and the question that follows is usually the wrong one: how do we absorb this? The better question is what decisions, made during open enrollment, could have changed that outcome.

Most HR and finance teams treat open enrollment like a deadline to clear. Hit the checklist, distribute the documents, close the window, move on. That framing is expensive. Open enrollment is the one moment each year when every employee is paying attention to their benefits, and when the structural decisions you make either compound your cost problem or start solving it.

In This Post

What Nonprofit Leaders Need to Know Before Enrollment Opens
Benefits Cost Trends and Benchmarking Data: What the Numbers Say for 2026
Cost Containment Strategies for Open Enrollment That Don't Cut Value
Using Your Benefits Selection Guide to Drive Retention, Not Just Enrollment
This Benefit Open Enrollment Guide Won't Help If You're Only Focused on Compliance
Work With a Benefits Advisor Who Understands Your Sector
Frequently Asked Questions

Key Takeaways

Rising Premium Cost	With family premiums averaging $26,993 in 2025 and Mercer projecting per-employee costs above $18,500 in 2026, doing nothing during open enrollment is itself a financial decision, just not a good one.
Cost Without Cuts	Dependent eligibility audits, contribution strategy adjustments, and voluntary benefit layering can all reduce what you spend without touching what employees actually receive.
Voluntary Benefit Demand Is Real	Voluntary dental enrollment is up 78% since 2023. Employees are actively seeking supplemental coverage. Organizations that offer it see stronger perceived value at no additional employer cost.
Enrollment as Leadership	The organizations that get the most from open enrollment treat it as a leadership moment with real retention consequences, not an annual compliance exercise someone in HR owns alone.

What Nonprofit Leaders Need to Know Before Enrollment Opens

Open enrollment is the annual window when employees can add, drop, or change their benefit elections for the coming plan year. Outside that window, changes only happen when a qualifying life event occurs: marriage, a new dependent, loss of other coverage. Miss the window, and you wait another year.

For nonprofits and healthcare organizations, that window carries extra weight. Your workforce is often mission-driven, paid below private-sector peers, and acutely aware of anything that affects their take-home value. A benefits change that lands poorly here does not just create noise. It creates turnover.

Most Southeast nonprofits run enrollment in October or November, with coverage effective January 1. Organizations on non-calendar fiscal years do it differently. Special enrollment periods can open mid-year when qualifying events occur. Missing those triggers creates compliance exposure and employee frustration that surfaces at exactly the wrong time.

On compliance: the ACA requires applicable large employers to offer minimum essential coverage to full-time employees or face penalties. ERISA governs plan documentation, summary plan descriptions, and fiduciary responsibilities. The common errors, distributing Summary of Benefits and Coverage documents late, failing to notify employees of special enrollment rights, sloppy dependent eligibility verification, are expensive and entirely avoidable.

A few edge cases trip up even experienced HR teams. Tobacco surcharges and working spouse surcharges are legally permitted under ACA wellness rules but need careful structuring to stay clear of discrimination claims. Dependent eligibility audits, done before enrollment closes, are one of the fastest ways to recover cost without redesigning anything. And with workplace flexibility now standard at 95% of nonprofits, your enrollment process needs to work entirely in a digital environment. Remote workers who can't complete enrollment from home are a problem you created.

Key terms worth knowing before the window opens:

HDHP (High-Deductible Health Plan): A plan with lower premiums but higher out-of-pocket costs before coverage kicks in, typically paired with a Health Savings Account (HSA) employees can use to offset those costs
Surcharge: An additional premium cost applied when employees engage in certain behaviors, such as tobacco use or enrolling a working spouse who has access to other coverage
Dependent verification: The process of confirming that individuals enrolled as dependents actually meet the plan's eligibility criteria

For a closer look at staying on the right side of federal requirements, the benefits compliance guide at Thrive Benefits Group is a practical starting point.

Benefits Cost Trends and Benchmarking Data: What the Numbers Say for 2026

Making benefits decisions without benchmarking is like negotiating a salary without knowing what the job pays anywhere else. You might get lucky. You probably won't know either way.

The 2025 KFF Employer Health Benefits Survey gives us the clearest current picture heading into 2026 planning:

Family premium (annual)	$26,993	Up 6% year over year
Single premium (annual)	$9,325	Up 5% year over year
Single deductible (avg)	$1,886	Varies by plan type
Medical coverage offered	99% of nonprofits	Near universal
HDHP adoption	42% of nonprofits	Growing steadily
Employer contribution range	50% to 70%	Stable across sectors

The number worth pausing on: voluntary dental enrollment is up 78% since 2023. That is not a rounding error. Employees are actively seeking supplemental coverage, and organizations that offer it see stronger enrollment numbers and higher perceived benefit value, without adding to employer cost. A good benefits selection guide doesn't just tell you what plans cost. It tells you where employee demand is moving before your competitors notice.

Mercer projects total per-employee health costs to exceed $18,500 in 2026, with a 6.5% increase, the highest since 2010. The Milliman Medical Index puts per-person growth at 7.9%. These are not outlier forecasts. If your planning assumptions are softer than that, they're already wrong.

Benchmarking tells you four specific things your renewal conversation can't:

Whether your premiums are competitive or an outlier in your region
Whether your employer contribution is aligned with peer organizations or quietly falling behind
Where voluntary benefit gaps exist that competitors may already be filling
What data your leadership team needs to defend decisions to a board or executive committee

In South Carolina specifically, nonprofit median salaries are up 17% since 2022, and more than 75% of SC nonprofits now offer medical, dental, vision, and paid time off as a standard package. That is the floor, not a differentiator. If you're not there yet, you're already behind the organizations you're competing with for talent.

For a structured way to apply this data to your planning cycle, the benefits checklist 2026 walks through each decision point in sequence.

Cost Containment Strategies for Open Enrollment That Don't Cut Value

Cost containment during open enrollment does not mean cutting benefits. It means being precise about where money goes and whether it's generating anything real in return.

The most effective moves to make during enrollment:

Migrate employees to lower-cost plan options. If you offer both a traditional PPO and a high-deductible plan (one with lower premiums but higher upfront costs), make sure employees actually understand the difference. Most people stay on the expensive plan out of habit, not because they've compared their options. Clear side-by-side cost comparisons move enrollment in ways that nothing else does.
Optimize your employer contribution strategy. Employer contributions in the 50% to 70% range are standard. Shifting from a flat-dollar contribution to a percentage-based model aligns your spend with actual plan costs and reduces the renewal surprises you didn't see coming.
Run a dependent eligibility audit. Ineligible dependents on your plan are a direct cost leak. A structured audit before enrollment closes is one of the fastest ways to recover spend without touching plan design.
Add or expand voluntary benefits. Dental, vision, life, and disability coverage offered on a voluntary basis shifts cost to the employee while increasing what they perceive they're getting. This is not a reduction in benefits. It is a smarter structure for delivering them.
Apply wellness incentives and surcharges deliberately. Tobacco-free discounts and working spouse surcharges, when properly structured, reduce cost and reward healthy behavior without creating compliance problems. Improperly structured, they create both.

Do not stop at the top-line premium increase when you're looking for cost drivers. Pull your claims data and find the three to five conditions generating the most spend. Chronic disease management, mental health utilization, high-cost specialty drugs, these often account for a disproportionate share of total cost and can be addressed through targeted plan design. The premium line does not tell that story on its own.

Employees who feel blindsided by cost shifts disengage or leave. Phased announcements, informational sessions, and written comparisons reduce resistance and improve outcomes. For more on structuring this process, see how cost savings with benefits brokers and benefits technology can reduce the administrative burden during enrollment.

Using Your Benefits Selection Guide to Drive Retention, Not Just Enrollment

Benefits are only as valuable as the employees who understand them. An employee who doesn't understand their benefits doesn't value them. That gap shows up in exit interviews, usually months after you could have done anything about it.

The difference between a traditional open enrollment approach and one that actually drives engagement isn't a budget question. It's a design question.

One email with a PDF attachment	Multi-channel campaign: email, video, in-person sessions
Enrollment deadline reminder only	Early education starting 4 to 6 weeks before deadline
Standard plan comparison sheet	Personalized total rewards statement
No feedback mechanism	Post-enrollment survey to capture gaps
HR answers questions reactively	Proactive Q&A sessions and decision-support tools

Proven engagement practices for the enrollment period:

Start communications at least four weeks before the enrollment window opens
Use plain language throughout, because jargon employees won't read is jargon that doesn't work
Offer multiple formats: written guides, short videos, and live sessions
Create a feedback loop so employees can surface confusion before it becomes dissatisfaction
Highlight the total value of the benefits package, not just what health insurance costs

If your workforce skews toward Medicaid-adjacent roles, behavioral health access is likely your top driver of quiet dissatisfaction. Behavioral health gaps in these populations are well documented and rarely addressed directly during enrollment. Surface your EAP resources and mental health benefits proactively. Employees who feel supported in this area are more likely to stay, and more likely to tell you when something isn't working, which is information you want.

Voluntary benefits, with voluntary dental enrollment up 78% since 2023, give employees flexibility and signal that you're paying attention to what they actually need. For more on building this kind of strategy, see HR's role in benefits and how employee benefits advocacy can shift the culture around enrollment. Understanding membership management basics can also inform how you segment communication for different parts of your workforce.

This Benefit Open Enrollment Guide Won't Help If You're Only Focused on Compliance

The organizations that get the most out of open enrollment are not the ones with the richest plans. They're the ones that treat the process as a leadership moment. That distinction matters more than any single plan design decision.

Compliance is the floor. When HR and finance teams spend all their energy on ACA checklists and ERISA documentation, they clear the bar and miss the opportunity. Open enrollment is the one time each year when every employee is paying attention to what you offer. That attention is brief. You don't get a second shot at it.

The best retention gains come from two things: flexible, layered offerings employees can actually customize to their situation, and two-way communication that makes them feel like someone thought about what they need. Neither requires a bigger budget. They require someone in leadership willing to own the process rather than hand it entirely to HR administration and walk away.

A customizable total rewards statement, a voluntary benefit that costs the employer nothing, or a simple post-enrollment survey can shift how an employee perceives their entire compensation package. CFOs and HR directors who lead this shift in 2026 will see it in their retention numbers. Those who don't will keep wondering why strong performers leave for organizations that pay less. The negotiating benefits in 2026 guide offers concrete leverage points for that conversation.

Work With a Benefits Advisor Who Understands Your Sector

Most nonprofits and healthcare organizations in the Southeast are leaving cost savings and retention value on the table during open enrollment, not from lack of effort, but from lack of a structured strategy applied at the right moment. Thrive Benefits Group works directly with CFOs and HR directors to bring benchmarking, plan analysis, and creative benefit design into your open enrollment process. Schedule a conversation to talk through your specific situation.

Schedule a Consultation

Frequently Asked Questions

When does open enrollment typically occur for nonprofits in the Southeast?

Most nonprofits and healthcare organizations hold open enrollment in the fall, typically October or November, ahead of the new benefits plan year beginning January 1. Organizations on non-calendar fiscal years may run on a different schedule.

What is the average employer contribution for nonprofit health plans?

Median employer contribution ranges from 50% to 70% of total premium costs for nonprofits, consistent with 2025 benchmarks and stable across sectors.

How can nonprofits reduce benefit costs without reducing employee value?

The most effective tactics are plan migration to lower-cost options, dependent eligibility verification, contribution strategy restructuring, and adding voluntary benefits that shift cost to employees without reducing perceived value. None of these require cutting plan richness.

Why is behavioral health access a priority issue during open enrollment?

Behavioral health gaps in organizations with Medicaid-adjacent workforces are a documented driver of employee dissatisfaction and turnover. Proactively surfacing EAP and mental health benefits during enrollment is one of the most underutilized retention levers available to HR and benefits teams.

What trends matter most for 2026 benefit planning?

Family premiums reached $26,993 in 2025, up 6% year over year, and Mercer projects per-employee health costs to exceed $18,500 in 2026. Voluntary dental enrollment has grown 78% since 2023. South Carolina nonprofits are raising both salaries and benefit value to stay competitive. Open enrollment planning built on last year's assumptions is already behind the curve.